With a looming state budget crunch forcing Wisconsin's special interests to fight for funding, hospitals in the cross-fire continue to wage war against radical legislative proposals.
Last week state legislators stunned hospitals for the second time in a month when they proposed two provisions for the annual budget bill that would give state regulators the task of controlling inpatient rates and pre-approving new construction projects.
Under the proposed budget provisions, starting in January 2004 hospitals would be required to seek approval from the Wisconsin Public Service Commission before increasing their prices. Wisconsin does not have a certificate-of-need program but would get one if the second proposal introduced last week survives the budget process.
The latest possible changes to Wisconsin's healthcare landscape now are competing with an even more controversial plan floated last month that would permanently ban hospital construction and renovation in the state (April 29, p. 18). According to state legislators, as of last week none of the recent healthcare proposals were officially in the state's proposed budget, which passed both chambers of the Legislature but is tied up in a conference committee working to reconcile the two versions. With the controversial healthcare proposals on the table of that committee, they stand a good chance of finding their way into the final budget bill, officials said.
"These bad ideas are one conference committee agreement away from becoming state law," said Steve Baas, press secretary for Scott Jensen, the Republican speaker of the Wisconsin State Assembly.
"This is one step forward and two huge steps back," said Eric Borgerding, vice president of government affairs for the Wisconsin Hospital Association, referring to the possibility that lawmakers would replace the construction ban with rate setting and CON requirements. "There's not one hospital in the state that thinks price controls are a good thing."
Legislators who favor the proposed budget provisions have argued that such measures would help put a lid on out-of-control healthcare spending. They believe regulating hospital prices and preventing construction can help shrink the state's $1.1 billion deficit.
Hospitals, meanwhile, were hardly relieved to learn the construction ban might be eliminated in favor of what they view as equally, if not more disturbing, proposals.
"If we're building a new hospital, even though it's a replacement, do we need to get a CON to do that? If the answer is yes, it could have a huge impact on the timing and planning of our hospital," said John Reiling, president and chief executive officer of St. Joseph's Community Hospital of West Bend, a 103-bed hospital in suburban Milwaukee that plans to start construction of a replacement facility later this year.
Under the CON proposal hospitals would have to secure approval from the Wisconsin Health and Education Facilities Authority before they could construct new facilities, transfer ownership of facilities, purchase new medical equipment exceeding $1 million, spend more than $2 million in capital expenses or terminate existing services.
Some hospitals say they think the proposals are so off target that they won't become law.
"It is widely understood that these approaches are not effective at truly addressing the drivers of rising healthcare costs, and therefore we do not believe that it will be passed as policy and law for the state of Wisconsin," said Kathy Schmitz, director of communications for Columbia-St. Mary's Health System, which is in the process of combining its two Milwaukee hospitals into a single campus. The new hospital, which will cost several hundred million dollars and house 350 to 400 beds, will break ground sometime next year pending approval from system sponsors, Schmitz said.
Wisconsin's proposed healthcare measures have not been subject to public comment or debate. If rate setting and CON provisions were introduced as stand-alone pieces of legislation, the WHA's Borgerding said, "they wouldn't see the light of day."